Subfascial endoscopic perforator vein surgery

Chronic venous insufficiency is a tremendous health care problem in western societies. Venous disease can affect any combination of the superficial, deep, and perforator venous systems of the lower extremities. Generally the superficial venous deficits are addressed through sclerotherapy, enovenous ablation, stab phlebectomy, and or stripping. Patients with advanced clinical sequelae (lipodermatosclerosis or ulceration) of CVI should also be evaluated for the presence of incompetent perforating veins. Open surgical approached to the calf perforating veins (ie. Linton procedure) were complicated by significant wound complications and have largely been replaced by the less invasive Subfascial Endoscopic Perforator Surgery (SEPS). The use of SEPS in patients with ulceration has been shown to be safe and to reduce the time that patients will have ulcers during follow-up. This chapter will review the pathophysiology, diagnosis, and treatment of incompetent perforating veins of the legs with particular attention to surgical issues.